Glycosylated hemoglobin as a predictor of mortality in severe pneumonia by COVID-19

Díaz, Jesús Salvador Sánchez; Moguel, Karla Gabriela Peniche; Escudero, Eduardo Alberto; Carpio-Orantes, Luis Del; Zepeda, Enrique Monares; Nieto, Orlando Rubén Pérez; López, Éder Iván Zamarrón; Deloya-Tomás, Ernesto; Gonzalez, Fernando Enrique Estrada; Torres, Jesús Díaz; Escarramán-Martínez, Diego; Guerrero-Gutiérrez, Manuel Alberto

doi:10.1080/17476348.2021.1926988

Cited by 5 publications

(2 citation statements)

References 22 publications

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“…Similarly, a meta-analysis 28 did not find a statistically significant association between HbA1c and disease severity. Sánchez Díaz et al further explored 29 the effect of high HbA1c levels on mortality outcome in a study of 56 patients requiring invasive mechanical ventilation due to COVID-19 ARDS. They were able to show an increased mortality in univariable analysis when dichotomising patients with HbA1c ≥ 6.5%, which they could not replicate in multivariable adjusted models.…”

Section: Discussionmentioning

confidence: 99%

Glycaemic variability is associated with all-cause mortality in COVID-19 patients with ARDS, a retrospective subcohort study

Hartmann

Verket

Balfanz

et al. 2022

Sci Rep

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There is high mortality among intensive care unit (ICU) patients with acute respiratory distress syndrome (ARDS) caused by coronavirus disease (COVID-19). Important factors for COVID-19 mortality are diabetes status and elevated fasting plasma glucose (FPG). However, the effect of glycaemic variability on survival has not been explored in patients with COVID-19 and ARDS. This single-centre cohort study compared several metrics of glycaemic variability for goodness-of-fit in patients requiring mechanical ventilation due to COVID-19 ARDS in the ICU at University Hospital Aachen, Germany. 106 patients had moderate to severe ARDS (P/F ratio median [IQR]: 112 [87–148] mmHg). Continuous HRs showed a proportional increase in mortality risk with daily glycaemic variability (DGV). Multivariable unadjusted and adjusted Cox-models showed a statistically significant difference in mortality for DGV (HR: 1.02, (P) < 0.001, LR(P) < 0.001; HR: 1.016, (P) = 0.001, LR(P) < 0.001, respectively). Kaplan–Meier estimators yielded a shorter median survival (25 vs. 87 days) and a higher likelihood of death (75% vs. 31%) in patients with DGV ≥ 25.5 mg/dl (P < 0.0001). High glycaemic variability during ICU admission is associated with significant increase in all-cause mortality for patients admitted with COVID-19 ARDS to the ICU. This effect persisted even after adjustment for clinically predetermined confounders, including diabetes, median procalcitonin and FPG.

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Section: Discussionmentioning

confidence: 99%

Glycaemic variability is associated with all-cause mortality in COVID-19 patients with ARDS, a retrospective subcohort study

Hartmann

Verket

Balfanz

et al. 2022

Sci Rep

View full text Add to dashboard Cite

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“…Previous studies suggested that hyperglycemia or hemoglobin A1c (HbA1c) might be associated with a poor prognosis in critically ill patients without diabetes ( 15 ). Several studies have found that HbA1c predicts ICU mortality in COVID-19 severe pneumonia, with patients with severe COVID-19 pneumonia having a higher 28-day mortality ( 16 ). Furthermore, compared to COVID-19 patients with a diabetes diagnosis, critically ill and COVID-19 patients with HbA1c levels above 6.5% and no prior diagnosis of diabetes had the highest risk of all-cause mortality ( 17 ).…”

Section: Introductionmentioning

confidence: 99%

The association between hemoglobin A1c and all-cause mortality in the ICU: A cross-section study based on MIMIC-IV 2.0

Liu

Pang²,

Tong³

et al. 2023

Front. Endocrinol.

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BackgroundHyperglycemia has been reported to be associated with the outcomes of patients in the intensive care unit (ICU). However, the relationship between hemoglobin A1c (HbA1c) and long-term or short-term mortality in the ICU is still unknown. This study used the Medical Information Mart for Intensive Care (MIMIC)-IV database to investigate the relationship between HbA1c and long-term or short-term mortality among ICU patients without a diabetes diagnosis.MethodsA total of 3,154 critically ill patients without a diabetes diagnosis who had HbA1c measurements were extracted and analyzed from the MIMIC-IV. The primary outcome was 1-year mortality, while the secondary outcomes were 30-day mortality and 90-day mortality after ICU discharge. HbA1c levels were classified into four levels according to three HbA1c values (5.0%, 5.7%, and 6.5%). The Cox regression model was used to investigate the relationship between the highest HbA1c measurement and mortality. Finally, this correlation was validated using the XGBoost machine learning model and Cox regression after propensity score matching (PSM).ResultsThe study eventually included 3,154 critically ill patients without diabetes who had HbA1c measurements in the database. HbA1c levels of below 5.0% or above 6.5% were significantly associated with 1-year mortality after adjusting for covariates in Cox regression (HR: 1.37; 95% CI: 1.02–1.84 or HR: 1.62; 95% CI: 1.20–2.18). In addition, HbA1c 6.5% was linked to 30-day mortality (HR: 1.81; 95% CI: 1.21–2.71) and 90-day mortality (HR: 1.62; 95% CI: 1.14–2.29). The restricted cubic spline demonstrated a U-shaped relationship between HbA1c levels and 1-year mortality. The AUCs of the training and testing datasets in the XGBoost model were 0.928 and 0.826, respectively, while the SHAP plot revealed that HbA1c was somewhat important for the 1-year mortality. Higher HbA1c levels in Cox regression were still significantly associated with 1-year mortality after PSM for other factors,ConclusionsThe 1-year mortality, 30-day mortality, and 90-day mortality rates for critically ill patients after discharge from ICU are significantly associated with HbA1c. HbA1c < 5.0% and ≥6.5% would increase 30-day, 90-day, and 1-year mortality, while levels between 5.0% and 6.5% of HbA1c did not significantly affect these outcomes.

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Association of COVID with Mycosis in General

Kaur,

Sumanpreet

et al. 2024

IDDT

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Background: The COVID-19 pandemic caused by SARS-CoV-2 is a respiratory disease which created havoc worldwide, was accompanied by another peculiar, otherwise rare, secondary fungal infection Mucormycosis which was observed at exceptionally high incidence in India during the second wave of COVID-19. The article explores possible links between the two infectious diseases to understand a higher-than-normal occurrence of Mucormycosis in COVID-19 patients. Coronavirus enters the patients through ACE-2 and many other receptors like- NRP-1, TfR, CD-126, and CD-26. Virus bind to cells possessing these receptors and affect their proper functioning, disturbing homeostatic metabolism and resulting in conditions like hyperglycemia, Diabetic Ketoacidosis (DKA), low serum pH, iron overload, anemia, hypoxia, and immunosuppression as explained in the article. All these outcomes provide a very supportive environment for the attack and spread of Mucormycosis fungi. The major receptor for Mucormycosis in humans is the GRP-78. Its expression is upregulated by coronavirus entry and by hyperferritinemia, hyperglycemia, and acidic conditions prevalent in COVID patients, thus providing an easy entry for the fungal species. Upregulation of GRP-78 furthermore damages pancreatic β-cells and intensifies hyperglycemia, showing quite a synergic relationship. Inordinate rise of Mucormycosis cases in India might be explained by facts like- India possessing a large proportion of diabetic patients, emergence of a very deadly strain of coronavirus- Delta strain, higher doses of steroids and antibodies used to treat patients against this strain, overburdened health care services, sudden much higher need of oxygen supply and use of industrial oxygen could explain the Mucormycosis outbreak observed in India during the second wave of COVID-19. Objective: The present review discusses the functional interdependence between COVID-19 and Mucormycosis and summarizes the possible synergic links between COVID and Mucormycosis. Conclusion: The receptors and metabolic pathways affected by COVID-19 result in severe physiological conditions- hyperglycemia, DKA, anemia, iron overload, immunosuppression, and hypoxia. All these conditions not only increase the expression of GRP-78, the major receptor for entry of fungi but also play a crucial role in providing quality media for Mucormycosis fungus to establish and grow. Hence explains the fungal epidemic observed in India during the second wave of COVID-19 in India.

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Glycosylated hemoglobin as a predictor of mortality in severe pneumonia by COVID-19

Cited by 5 publications

References 22 publications

Glycaemic variability is associated with all-cause mortality in COVID-19 patients with ARDS, a retrospective subcohort study

Glycaemic variability is associated with all-cause mortality in COVID-19 patients with ARDS, a retrospective subcohort study

The association between hemoglobin A1c and all-cause mortality in the ICU: A cross-section study based on MIMIC-IV 2.0

Association of COVID with Mycosis in General

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